Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 004609 | PR |
Y | 1041C0700X | Clinical Social Worker | 6343 | PR |
NPI | 1063633154 |
---|---|
Provider Name | Mrs. Ghislaine Rivera |
First Address | Carolina, PR 00987 |
Second Address | Carolina, PR 00987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 21/03/2017 |